Reference Manual - IARC Screening Group

Infection Prevention ProcessesDECONTAMINATIONTable C-1. Infection Prevention Guidelines for Processing Instruments, SurgicalGloves and Other Items (continued)HIGH-LEVEL DISINFECTIONHigh-level disinfection by boiling, steaming or using chemicals is acceptable forfinal processing of instruments and surgical gloves used for VIA or cryotherapy.Surgical (metal) instruments and surgical gloves should be steamed or boiled for20 minutes and allowed to dry. Instruments can be soaked for 20 minutes in 0.1%chlorine solution prepared with boiled water or 2–4% glutaraldehyde * , thoroughlyrinsed in boiled water and air dried.Use immediately or store for up to 1 week in a dry, high-level disinfected containerwith a tight-fitting lid or cover.STERILIZATIONInstruments and surgical gloves can be sterilized by autoclaving. If necessary, metalinstruments can be sterilized using dry heat.Steam sterilization: 121°C (250°F) at 106 kPa (15 lb/in 2 ) pressure for 20 minutesfor unwrapped items; 30 minutes for wrapped items. Allow all items to drythoroughly before removing.Dry heat:• 170°C (340°F) for 60 minutes (total cycle time—placing instruments in oven,heating to 170°C, timing for 1 hour and then cooling—is from 2 to 22 hours),or• 160°C (320°F) for 2 hours (total cycle time is from 3 to 32 hours).Note: Dry heat sterilization (170°C for 60 minutes) can be used only for metalinstruments.Storage: Unwrapped instruments must be used immediately or stored in dry sterilecontainers (1 week only). Wrapped instruments, such as surgical gloves, can bestored for up to 1 week if the package remains dry and intact and for up to 1 monthif sealed in a plastic bag.* Glutaraldehyde is a toxic agent. Use in well-ventilated areas and limit exposure time.Decontamination makes objects safer to handle by staff before cleaning.It is the first step in handling soiled surgical instruments and other items.It is important to decontaminate instruments and items that may havebeen in contact with blood or body fluids. Immediately after use, placeinstruments and other items in a 0.5% chlorine solution for 10 minutes.This step rapidly inactivates HBV and HIV and makes items safer tohandle.Making a DiluteChlorine SolutionThe World Health Organization (WHO) recommends 0.5% chlorinesolution for decontaminating instruments before cleaning or when potablewater is not available for making the solution (WHO 1989). For HLD, a0.1% solution is satisfactory, provided boiled water is used for dilution.Table C-2 describes how to make 0.5% and 0.1% chlorine solutionsusing commercially available liquid bleach products. The general formulaC-2 Cervical Cancer Prevention Guidelines for Low-Resource Settings